Prescription Plan Clause Samples
A Prescription Plan clause outlines the terms and conditions under which prescription drug benefits are provided to participants in a health or employee benefits plan. It typically details which medications are covered, the process for obtaining prescriptions, any copayments or deductibles required, and any limitations or exclusions that apply, such as formulary restrictions or prior authorization requirements. By clearly defining the scope and rules of prescription drug coverage, this clause ensures participants understand their benefits and helps manage costs and access to necessary medications.
Prescription Plan. 1. The Board will provide a prescription plan for all employees and their dependents, as limited by Section A, above.
2. The co-payment for over the counter brand name prescription drugs $25.00 and the co-payment for over the counter generic prescription drugs shall $10.00. The co-payment for mail order brand name prescription drugs shall be $21.00, and the co-payment for mail order generic prescription drugs shall be $11.00. There shall be no major medical coverage for these co-payments. Retail prescriptions shall be limited to a 30 day supply; mail order maintenance prescription drugs will be limited to a 90 day supply.
Prescription Plan. Effective 7/1/18, the HMO prescription plan will revert 18 to a three (3) system by the provider. Retail co-pay per thirty (30) day 19 prescription: $10 formulary; and $35 non-formulary. Mail order co-pay 20 for up to ninety (90) day prescription supply: $5 generic; $5 generic, $10 21 formulary; and $35 non-formulary. 22
Prescription Plan. The PPO plan will include a comprehensive prescription 29 program:
Prescription Plan. The prescription plan is bundled with a Medical plan, meaning the pharmacy benefit can only be accessed if the employee has enrolled in a UT medical plan. For generic drugs, the employee gets the cheaper of cost + $1 or flat fee. Retail UT Pharmacy Locations 30-day supply Tier 1 (Generic) Only a 10 day emergency supply is available @ $7.99 $7.99 Tier 2 (preferred Brand) Only a 10 day emergency supply is available @ $19.97 $19.97 Tier 3 (non-preferred Brand) Only a 10 day emergency supply is available @ $39.93 $39.93 31-90 day supply Tier 1 (Generic) n/a $19.97 Tier 2 (preferred brand) n/a $37.27 Tier 3 (non-preferred brand) n/a $73.93 Full-time regular permanent and eligible regular permanent part-time employees may have a prescription filled at both of the University of Toledo Out-Patient Pharmacies while enrolled in a University of Toledo sponsored medical/prescription plan. Non-emergent prescriptions can be dropped off in the OP Pharmacy during normal business hours or in the prescription drop box at any time but will only be available to be picked up in the OP pharmacy during regular outpatient pharmacy hours. Only cash, credit, or debit cards will be accepted as forms of payment. Emergent prescriptions when the OP pharmacy is closed can be filled at any University sponsored plan participating pharmacy for an emergency 10-day supply. Employees may be able to fill prescriptions under their spouse’s health plan as well as pick up over the counter medications and other supplies. The Outpatient pharmacy staff can assist in identifying coverage under other plans. Members are expected to show their current prescription benefit card, supplied to you by the prescription benefit manager, at the time of fill. Prescriptions may be filled for up to a 3 month period based on valid Physician order. If an employee insists on a brand name drug when a generic is available, they will have to pay 100% of the difference between the generic cost and the brand name drug cost. The formulary used will be the National formulary of the current prescription benefit manager including preauthorization, quantity management and Step Therapy protocols. Non-specialty medication prescriptions may be filled at the UT pharmacies for up to a 90-day supply based on valid provider order. Specialty medications are limited to UT pharmacies and will be filled for a 30-day supply. Other than prescriptions for chronic conditions, over the counter drugs will not be covered under the prescription ...
Prescription Plan. 100 Day Supply): Retail Generic and Non-Formulary co- 37 pays are $5; Retail Brand co-pay is $10 effective 7/1/17. 38 39 b. HMO Plan. 40 Brief description of coverage: Effective March 1, 2013, this plan will be 41 referred as the HMO TALB plan. The ability to move between the HMO and 42 Comprehensive Major Medical is no longer available. Continuation of 43 existing plan without modification of benefits, except as noted. 44 1 HMO. Office visits, $10; no deductible; hospitalization 100% covered.
Prescription Plan. The Board of Education will pay the premium of the New Jersey Blue Cross Prescription Plan for the employee and family. The prescription co-pay will be twenty dollars ($20) for brand name, ten dollars ($10) for generic drugs. Chronic illness prescriptions can be obtained through a mail order program with a one time co-pay for each mail order supple of twenty dollars ($20 for brand name and ten-dollar ($10) for generic drugs.
Prescription Plan. Prescription drug coverage will be continued as in previous contract, with the exception of deductibles. Beginning August 1, 2004, the following deductibles are applicable: $15 brand name; $8 generic; single co-pay mail order.
Prescription Plan. The Board agrees to provide single-person prescription coverage. The employee co- pay for the prescription plan is $15 for mail order/$20 for generic/$25 for name brand. Prior to July 1 of each year covered by this Contract, employees may waive their prescription coverage for the succeeding year and be compensated as per the following schedule: Single: $ 300.00 Provision will be made for re-entry into prescription coverage in the event of material change in the employee's situation, for example, loss of spousal coverage.
Prescription Plan. (1) Each employee is provided with an I.D. Card. On receipt of eligible prescriptions, the employee will pay the pharmacist two (2) dollars and present the I.D card. (The policy will provide the same eligibility rules for students until age 25 as per other benefits).
(2) The plan will continue to utilize “generics” where possible.
(3) The Dynamic Therapeutic Drug Formulary will apply to all active employees and their eligible dependants and Ontario Drug Benefit Formulary (ODBF) shall apply to all eligible retirees and their surviving spouses. .
(4) Only drugs requiring a prescription from a physician, legally licensed to practice medicine shall be covered (i.e. no Over The Counter drug coverage). OTC drug products to be covered include the following: *for which there are no alternatives, and lack of access to them could lead to life, limb, or organ-threatening disease; *required for use in combination with another ODB (Ontario Drug Benefit) covered drug product; *whose removal would likely lead patients to switch to other toxic and/or more costly alternatives; *used to treat a communicable disease with a significant public health impact;
(5) there shall be an $8.00 maximum on drug dispensing fees .
(6) Cost of prescription co-pay will be 90% paid by the Company and 10% paid for by the employee. All other payments requirements will continue as per the terms of the current CBA
Prescription Plan. (a) The District will continue to provide a prescription drug insurance program for active employees enrolled and their qualified enrolled dependents.
(b) Effective January 1, 1990, or as soon as the change can be effected, prescription drug coverage for employees enrolled in an H.M.O. medical plan will be provided through the H.M.O.